title: Indications and risks of delayed sternal closure after open heart surgery in neonates and early infants.
abstract: BACKGROUND
  Delayed sternal closure (DSC) has been an essential part of neonatal and infant heart surgery. Here, we report our single institution experience of DSC for eight years.
  
  
  METHODS
  The successive 188 patients were analyzed retrospectively. Sternum was closed at the end of the operation in 97 (51.6%) patients (primary sternal closure [PSC] group). Sternum was left open in 91 (48.4%) patients. Among them, 45 (23.9%) had only skin closure (DSCs group) and 46 (24.4%) had membrane patch closure (DSC membrane [DSCm] group). Median age was higher in PSC group (90 days) than DSCs (11 days) and DSCm groups (9.5 days).
  
  
  RESULTS
  Mortality was 1%, 11.1%, and 28.2% in PSC, DSCs, and DSCm groups, respectively (P < .05). Univariate analysis recognized the neonatal age (odds ratio [OR] = 4.2), preoperative critical condition (OR = 5.3), cardiopulmonary bypass time >180 minutes (OR = 4), and cross clamp time >99 minutes (OR = 3.9) as risk factors for mortality. Total morbidity rate was higher in DSCm group (73.9%) than DSCs group (51.1%) and PSC group (23.7%; P < .001). Mechanical ventilation time, intensive care unit stay, and hospital stay were longer in DSCs and DSCm groups than PSC group (P < .001). The incidence of hospital infection was also higher in DSCs (43.5%) and DSCm (33.3%) groups than PSC group (20.6%; P < .05). But there was no difference in the incidence of sternal wound complications, including both deep and superficial (4.1%, 8.8%, and 4.4%, respectively).
  
  
  CONCLUSIONS
  Although the risk of sternal wound complications is not different, patients who necessitate DSC (using both skin and membrane closure techniques) have more complicated postoperative course than patients with PSC.
authors.affiliation: Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Cardiovascular Surgery Department, Istanbul, Turkey.
authors.forename: Ersin
authors.initials: E
authors.lastname: Erek
authors.forename: Yusuf Kenan
authors.initials: YK
authors.lastname: Yalcinbas
authors.forename: Yasemin
authors.initials: Y
authors.lastname: Turkekul
authors.forename: Arda
authors.initials: A
authors.lastname: Saygili
authors.forename: Ayse
authors.initials: A
authors.lastname: Ulukol
authors.forename: Ayse
authors.initials: A
authors.lastname: Sarioglu
authors.forename: Cafer Tayyar
authors.initials: CT
authors.lastname: Sarioglu
keywords: complications; congenital heart surgery; infant; neonate